Impact of education, income and chronic disease risk factors on mortality of adults: does ‘a pauper-rich paradox’ exist in Latin American societies?

Koch, Elard; Romero, Tomás; Romero, Camila X.; Akel, Carlos; Manríquez, Leopoldo; Paredes, Mario; Román, Carolinne; Taylor, Alan; Vargas, M. Frías; Kirschbaum, A

doi:10.1016/j.puhe.2009.11.008

Cited by 29 publications

(20 citation statements)

References 40 publications

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“…In life course epidemiology, education is considered to be a measure of both early life circumstances (as the opportunities available to an individual are likely to be patterned by parental social class), and future socioeconomic trajectory [93]. Therefore, education may have an ‘antecedent’ role to economic development indicators, such as income, clean water supply, sanitary sewer access and other environmental variables [31]. Furthermore, education promotes increasing autonomy, awareness, responsibility and knowledge for self-care, healthy lifestyles and behaviours [13], [71], [92].…”

Section: Discussionmentioning

confidence: 99%

“…Recent Chilean prospective studies have corroborated the finding that educational attainment is a strong independent predictor of all-cause mortality having simultaneously a modulating effect on other factors [16], [31]. Although it has been suggested that increasing women's education level contributes to the modulation of other variables known to influence maternal health such as the reproductive behaviour ( e.g.…”

Section: Introductionmentioning

confidence: 88%

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Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

et al. 2012

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BackgroundThe aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs).MethodsTime series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957–2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.ResultsDuring the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (−13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (−1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (−69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.ConclusionIncreasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

et al. 2012

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“…[32] These gradients are firmly documented in the industrialized world. Research published in recent years supports the social gradient model in Latin America - with, for example, clear gradients for both men and women in chronic disease risk factors by educational attainment in Brazil [33] and Chile [34]. …”

Section: Introductionmentioning

confidence: 97%

Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda

Maio

2011

Globalization and Health

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Although chronic non-communicable diseases are traditionally depicted as diseases of affluence, growing evidence suggests they strike along the fault lines of social inequality. The challenge of understanding how these conditions shape patterns of population health in Latin America requires an inter-disciplinary lens. This paper reviews the burden of chronic non-communicable diseases in the region and examines key myths surrounding their prevalence and distribution. It argues that a social justice approach rooted in the idea of health inequity needs to be at the core of research in this area, and concludes with discussion of a new approach to guide empirical research, the 'average/deprivation/inequality' framework.

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“…18 Still, while studies linking socioeconomic conditions with chronic diseases are abundant in high-income countries, 19,20 their relation is yet not well understood in middle and low income economies. 21,22 …”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Status and Self-Reported Chronic Diseases among Argentina's Adult Population: Results Based on Multivariate Probability Models

Viego

Temporelli

2017

Journal of Public Health Research

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BackgroundHypertension, diabetes and hypercholesterolemia are the most frequent and diagnosed chronic diseases in Argentina. They contribute largely to the burden of chronic disease and they are strongly influenced by a small number of risk factors. These risk factors are all modifiable at the population and individual level and offer major prospects for their prevention. We are interested in socioeconomic determinants of prevalence of those 3 specific diseases.Design and methodsWe estimate 3-equation probit model, combined with 3 separate probit estimations and a probit-based Heckman correction considering possible sample selection bias. Estimations were carried out using secondary self-reported data coming from the 2013 Risk Factor National Survey.ResultsWe find a negative association between socioeconomic status and prevalence of hypertension, cholesterolemia and diabetes; main increases concentrate in the transition from low to high SES in hypertension and diabetes. In cholesterol, the major effect takes place when individual crosses from low to middle SES and then vanishes. Anyway, in Argentina SES exhibit and independent effect on chronic diseases apart from those based on habits and body weight.ConclusionsPublic strategies to prevent chronic diseases must be specially targeted at women, poorest households and the least educated individuals in order to achieve efficacy. Also, as the probability of having a condition related to excessive blood pressure, high levels of cholesterol or glucose in the blood do not increase proportionally with age, so public campaigns promoting healthy diets, physical activity and medical checkups should be focused on young individuals to facilitate prophylaxis.Significance for public healthLatin American countries are going through an epidemiological transition where infectious illnesses are being superseded by chronic diseases which, in turn, are related to lifestyles and socioeconomic factors. Specificities in the relationship between chronic diseases and socioeconomic status have been recorded in high income countries, but has not been sufficiently studied in low and middle income countries. We believe that analysis grounded on large scale datasets, recently available in Argentina, and based on proper statistical tools can provide useful guidance for decision making in public health policies as they highlight where population needs and risks do concentrate.

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Impact of education, income and chronic disease risk factors on mortality of adults: does ‘a pauper-rich paradox’ exist in Latin American societies?

Cited by 29 publications

References 40 publications

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda

Socioeconomic Status and Self-Reported Chronic Diseases among Argentina's Adult Population: Results Based on Multivariate Probability Models

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